Indigenous AOD Workers Wellbeing: An Examination of Individual, Organisational & Systems Factors

1
Indigenous AOD Workers Wellbeing An Examination
of Individual, Organisational Systems Factors

• Professor Ann Roche
• Ms Donna Weetra
• Ms Amanda Tovell
• Dr Toby Freeman
• Mr Allan Trifonoff
• National Centre for Education and Training on
  Addiction (NCETA)
• www.nceta.flinders.edu.au

Flinders Aboriginal Health Research Unit
Seminar Monday 25 August 2008
2
Acknowledgement of Country
We recognise Kaurna people and their land
The National Centre for Education and Training on
Addiction (NCETA) acknowledges that we are
meeting on the traditional country of the Kaurna
people of the Adelaide Plains. We recognise and
respect their cultural heritage, beliefs and
relationship with the land. We acknowledge that
they are of continuing importance to the Kaurna
people living today.
3
Indigenous AOD Worker Wellbeing (1)

• NCETA is researching the wellbeing of Indigenous
  and non-Indigenous alcohol and other drug (AOD)
  workers.
• Funded by the Australian Government Department of
  Health and Ageing (Indigenous and
  Psychostimulants section).
• Cooperative Research Centre for Aboriginal Health
  (CRCAH) in-kind project (for Flinders University).

4
Indigenous AOD Worker Wellbeing (2)

• National study includes AOD specialist and
  generic health workers across government and
  non-government agencies and community controlled
  organisations.
• Designed to identify factors that contribute to
  Indigenous workers wellbeing and stress and
  burnout.
• Will facilitate the development of effective
  strategies to help attract, reward and retain
  workers in the AOD field.

5
Project Aims

• To identify the key antecedents and consequences
  of stress, burnout and wellbeing amongst
  Indigenous AOD workers.
• To develop an information base and a range of
  tools to inform strategies to improve worker
  wellbeing and reduce stress and burnout.
• NCETA has also been requested to include
  non-Indigenous AOD workers whose clients are
  predominantly Indigenous.

6
Project Reference Group

• Coralie Ober (Queensland Alcohol and Drug
  Research and Education Centre)
• Scott Wilson Sharon Drage (Aboriginal Drug and
  Alcohol Council SA Inc)
• Mick Gooda (Cooperative Research Centre for
  Aboriginal Health)
• Colin Dillon (Queensland University of
  Technology)
• Don Hayward (Southern Adelaide Health Service)
• Amy Cleland (University of South Australia)
• Alwin Chong (Aboriginal Health Council of South
  Australia)

7
AOD Workers Managers Satisfaction,
Stress Wellbeing
www.nceta.flinders.edu.au
8
NCETA Previous Work on Worker Wellbeing
Workforce Development

• Alcohol and Other Drug (AOD) work is rewarding
  but demanding.
• Significant challenges related to
• Client population
• Community attitudes towards addiction
• Increasing complexity of client presentations
• Lack of resources and excessive workloads.

9
Excessive Job Demands

• Work overload
• Role conflict
• Role ambiguity
• Difficult clients
• Poor physical work environment

10
Lack of Job Resources

• Job autonomy
• Social support
• Remuneration
• Perceived reciprocity
• Knowledge of performance
• Professional development

11
Special Challenges for Indigenous Workers

• AOD qualifications for Indigenous workers are a
  relatively recent development.
• The Indigenous AOD field is relatively small.
• Responding to AOD issues often falls to workers
  such as Aboriginal Health Workers with general
  health qualifications.

12
Project Components

• Literature review
• Written / telephone submissions
• Online survey
• Site visits (face-to-face interviews and focus
  groups), and telephone interviews

13
Literature Review

• Indigenous client base issues
• Cultural competence for non-Indigenous health
  workers
• AOD workforce issues
• Indigenous health workforce issues
• Rural and remote issues

14
Indigenous Client Base Issues

• Grief and loss issues, extent of trauma, loss of
  land (Halloran, 2004 Ratnavale, 2007)
• The recent history of Aboriginal and Torres
  Strait Islander communities, is one of loss of
  land (often accompanied by violence), forced
  removal, and detention of differing clans in
  missions and reserves, with consequent loss of
  culture, autonomy, identity and life skills.
• Many patients come from such traumatised family
  backgrounds.
• Dealing constantly with traumatised patients
  can become a threat to the wellbeing of staff
• (Panaretto Wenitong, 2006, p. 528)
• Community acceptance potential gender, age,
  family issues (Trugden, 2000 Bartick Dixon,
  2005)

15
Cultural Competence for Non-Indigenous Health
Workers

• Insufficient appropriate cross-cultural skilling
  for non-Indigenous health workers (Harris
  Robinson, 2007)
• One of the most significant work-related stress
  factors described by Aboriginal Health Workers is
  the need to work with non-Aboriginal staff whose
  expectations and behaviour are grounded in a
  different culture and different health setting.
• (Howard, 2007)

16
Indigenous Health Workforce Issues

• Under-representation in health workforce
• 1 of workforce (Pink Allbon, 2008)
• 2.5 of Australian population (ABS, 2007)

• Wage disparity In a comparison of 12 selected
  community service occupations (Australian
  Services Union, 2007)
• Aboriginal health workers received the lowest
  average weekly pay (547.76)
• lower than childrens care workers (second lowest
  at 570.09)
• welfare and community workers (877.54)
• counsellors (905.95)
• social workers (909.89)

17
Indigenous Health Workforce Issues

• Support from management and the organisation
  esp. in mainstream organisations (Whiteside et
  al. 2006)
• Lack of clarity around role and tasks
• The welfare workers think the health workers
  could do more to assist welfare and housing
  issues, the doctors think they could do more to
  assist clinical management, and the transport
  workers think they could reduce the burden of
  demand by treating more patients at home.
  (Genat, 2006111)

18
AOD Workforce Issues

• NCETA has conducted national research on
  wellbeing, stress, and burnout in the AOD
  Workforce (Duraisingam et al., 2006)
• Main predictors of high work stress
• Role overload
• Low job autonomy
• High client-related pressure
• Low workplace social support, and
• Few professional development opportunities.

19
Rural Remote Issues

• Difficulties recruiting appropriate staff (VAADA
  2003)
• Large gap between community needs and available
  services (ANCD, 2001)
• Isolation, lack of privacy (Gray et al. 2004)
• Access to training (CIRC et al., 2001, NSW Mental
  Health Co-ordinating Council, 2005).

20
Ethics Approval
Two separate ethics stages 1) Online /
paper-based survey 2) Site visits interviews
and focus groups 1 approved through Flinders
University Social and Behavioural Research Ethics
Committee and Yunggorendi First Nations Centre
for Higher Education and Research. 2 sent to a
range of committees across Australia with the
first application and approval included in
package.
21
Ethics Approval for Site Visits

• Aboriginal Health Council of South Australia
  Ethics Committee
• Aboriginal Health and Medical Research Council
  Ethics Committee (New South Wales)
• Western Australian Aboriginal Health Information
  and Ethics Committee
• Ethics support and advice provided by Yunggorendi
  First Nations Centre for Higher Education and
  Research
• Flinders University Social and Behavioural
  Research Ethics Committee

22
Ethics Issues

• Used the NEAF (National Ethics Application Form)
  for the different Human Research Ethics
  Committees (HRECs) (except WA).
• Difficulty in identifying which HRECs we should
  be applying to.
• Requisite letters of support from participating
  organisations.
• Acknowledgement vs anonymity, confidentiality.

23
Written / Telephone Submissions Process

• Call for submissions commenced in April 08 and
  closed in June 08.
• 220 emails and 200 written invitations sent to
  420 organisations.
• Input sought from managers and frontline workers
  in AOD treatment agencies, government and
  non-government health services, community
  controlled health organisations, in addition to
  representatives from Indigenous communities and
  peak bodies.

24
Submissions Key Themes Issues

• Factors that contribute to worker wellbeing
• Factors that contribute to worker stress
• Balancing work / life issues
• Access to training
• Challenges meeting client and community needs
• Challenges organisational

Ive been working in this field for 18 years and
this is the first time we as workers have ever
been asked to tell our story
25
Online Survey

• Commenced in July 2008
• Survey instrument includes
• Mental health questions from the Indigenous Risk
  Impact Screen (IRIS)
• Cultural Respect Framework questions developed
  by NCETA staff members
• Work / Life Balance questions adapted from the
  Centre for Work Life, based at University of SA

26
Invitation to Participate in Online Survey
We would like to hear your views about what
effects worker wellbeing in the alcohol and other
drugs (AOD) field, from your experience as an
Indigenous worker, or a non-Indigenous worker who
has significant contact with Indigenous clients.

• Please log on to the NCETA website and follow the
  links to the survey www.nceta.flinders.edu.au.
• You will need about 20 minutes to complete this
  survey. Hardcopies can be provided if internet
  access is problematic.

27
Indigenous AOD Database

• Historically began as a mailing list for internal
  use.
• Grew into comprehensive listing of contact
  details, websites and Accessibility / Remoteness
  Index of Australia (ARIA) categories for over
  480 organisations and networks.
• Includes information about Indigenous AOD, mental
  health and comorbidity courses.
• Being produced and disseminated as a CD-ROM and
  will be accessible via the NCETA website.

28
Indigenous-Specific Accredited AOD, Mental Health
Comorbidity Courses
29
Site Visits / One-on-One Interviews

• Interview protocols for focus groups and
  one-on-one interviews have been completed and
  trialled partly informed by the submissions.
• Pool of potential sites being identified and
  confirmed.
• Site visits will occur nationally and will
  combine metropolitan / rural / remote sites.

30
Networking / Promotion

• Face-to-face meetings / conferences /
  word-of-mouth.
• Email notifications through listservers e.g.
  Alcohol and Other Drugs Council of Australia
  (ADCA), Australian Indigenous HealthInfoNet
  yarning places.
• Newsletter articles e.g. Aboriginal Health
  Council of SA (AHSCA), Cooperative Research
  Centre for Aboriginal Health (CRCAH), Public
  Health Association of Australia (PHAA).
• Attendance at celebrations and community
  consultations.

31
Summary

• Two year project commenced in mid-2007.
• Builds upon NCETAs previous work on worker
  wellbeing, stress and burnout in the AOD field.
• Written / telephone submissions process complete.
• Literature review ongoing.
• Resources database nearing completion.
• Online survey is currently live.
• Site visits / focus group / one-on-one /
  telephone interviews to be conducted in SeptDec
  2008.

32
NCETA Resources

• Practical tools
• Stress and Burnout Booklet
• Clinical Supervision Resource Kit (available
  electronically only)
• Workforce Development TIPS Kit
• Available from www.nceta.flinders.edu.au

33
Thank You from the Project Team
Dr Toby Freeman Ms Donna Weetra Professor Ann
Roche Ms Amanda Tovell Mr Allan Trifonoff
www.nceta.flinders.edu.au